NDD-Parkinson's Disease Flashcards
T or F: Parkinson’s disease affects the younger population.
False, it occurs most frequently in later adulthood, with a mean onset age of 55-60 years
What is the basal ganglia?
The gray matter that contributes to complex movements
Where do major degenerative changes occur for patients with PD?
basal ganglia
When the substantia nigra becomes depigmented it affects the production of what neurotransmitter?
dopamine
What does dopamine influence?
The speed and accuracy of motor skills, postural stability, cognition, and affect and expression.
T or F: The loss or reduction of dopamine leads to the disabling symptoms
True
T or F: The exact cause of PD is unknown
True, it has been attributed to both heredity and environment. 50% of people with PD have a relative who is also affected, which may indicate a genetic factor.
What is secondary parkinsonism?
A condition in which people experience symptoms similar to those of PD, but the cause is related to the ingestion of drugs or other toxic chemicals.
What are the primary symptoms of PD?
resting tremor, muscle rigidity, bradykinesia and postural instability
Which primary symptom is a typical early sign of PD, which affects one side and is described as a “pill-rolling” movement of the hand?
resting tremor
T or F: Tone is increased, adversely affecting movement in individuals with PD.
True
What are cogwheel motions?
Jerky, sometimes painful movements with joint mobility, most commonly in the UE.
T or F: Fatigue becomes a barrier to occupational performance because of increased effort to produce voluntary movement.
True
What is known as extreme slowness observed when initiating or performing volitional movements?
bradykinesia
What are some examples of bradykinesia?
shuffling gait, difficulty moving from sitting to standing, freezing and increased time required for fine motor tasks such as shaving or fastening clothes
How do individuals with PD present with posture?
Posture is stooped, with a lack of arm swing during mobility and loss of postural reflexes
T or F: Fall risk is increased with patients with PD, especially when balance is challenged.
True
What should you do to address rigidity and associated pain in patients with PD?
Use moist heat, stretching and gentle ROM
T or F: it’s easy to see when patients with PD are experiencing pain.
False; their masklike facial expression make it imperative to diligently monitor pain during all exercises and stretching
What splints could you use for clients with PD who have contractures?
An antispasticity splint, dynamic or static progressive splint
What can splints help with in patients with PD with contractures?
Gives the patient a low intensity stretch against the contraction of the antagonist muscles
T or F: colder temperatures help decrease muscle stiffness
False, cold temperatures increase muscle stiffness
T or F: its not beneficial for a client with PD to have a sedentary job that requires minimal communication
False; that kind of job is a better fit for them. Jobs to be avoided are those that require extensive gross motor movements, such as walking, reaching or bending (because of balance and gait deficits) and entail high stress levels.
T or F: it is best to work on self care activities farther away from the body
False; it’s better to do it as close to the body as possible and when appropriate support the upper extremity
What is a good way to improve nonverbal communication in patients with PD?
Use a mirror to increase the clients awareness of facial expression
A secondary symptom of PD that may occur in some clients known as the inability to initiate or continue movement is known as what?
Freezing
T or F: Clients with PD may undershoot targets as it is a secondary symptom of PD
False, they overshoot - such as taking five or six small steps past the goal
In later stages of PD, what cognitive deficit may occur as a secondary symptom in some clients?
dementia
What are some cognitive deficits that are secondary symptoms for clients with PD?
impaired executive functioning, memory loss and visuospatial deficits.
T or F: Clients with PD may experience only verbal, not written, communication difficulties.
False, they can be verbal, nonverbal and/or written difficulties
What is known as smaller and smaller handwriting?
micrographia
what is known as hypophonia?
reduced volume of speech
What are some communication difficulties a client with PD may have?
micrographia, hypophonia, muffled speech, lack of verbal inflection and reduced facial expression or flat affect (infrequent eye blinking) affecting nonverbal communication.
T or F: Clients with PD may experience some sensory loss including bowel and bladder as well as sexual dysfunction.
True
What causes an increase in saliva and subsequent drooling, slower and more intentional eating and episodes of coughing and choking in patients with PD?
dysphagia
What are some mood and behavior disturbances associated with patients with PD?
depression, apathy, lack of initiative, disinterest, social isolation and withdrawal.
PD is confirmed with a..
autopsy
what are some tests that can be run to eliminate the diagnosis of other neurological causes?
CAT scan, MRI, electroencephalography
T or F: Symptoms of PD may take years to develop but they may gradually experience a loss of function and increasing disability.
True
T or F: There is no cure for PD
True
T or F: Disease progression is not always linear; functioning may fluctuate and even show occasional improvement.
True
T or F: Life expectancy is affected in clients with PD
False, it is rarely affected as a result in medical advances
How many stages are there for PD?
Five
Which stage of PD is described as total dependence for mobility and ADLs?
stage 5
Which stage of PD is described as a decrease in postural stability, decrease in function, impaired mobility, need for assistance with ADLs, poor fine motor and dexterity?
stage 4
Which stage of PD is when unilateral symptoms show, typically a resting tremor, with no or minimal loss of function?
stage 1
Which stage of PD is when impaired balance occurs secondary to postural instability resulting in mild to moderate impairments in function?
stage 3
Which stage is when bilateral symptoms show, balance is not affected, although problems develop with trunk mobility and postural reflexes?
stage 2
What are some surgical options available to clients with PD if medications do not help control symptoms?
Thalamotomy, pallidotomy, deep brain stimulation and tissue implantation
What surgical option involves the application of heat via an electrode or y-knife radiosurgery to destroy part of the thalamus, which contributes to movement, to reduce tremors?
thalamotomy
How long do the effects of thalamotomy last?
more than 10 years
What surgical option involves the application of heat via an electrode or y-knife radiosurgery to destroy part of the globus pallidus, which contributes to movement, to reduce tremors, shuffling gait, flat affect, rigidity and bradykinesia?
Pallidotomy
How long do the effects of pallidotomy last?
about 5 years
What surgical option involves the delivery of electrical impulses to areas of the brain through an implanted device similar to a pacemaker to reduce tremors? (The electrode is tunneled under the skin to an external switch that the person with PD can turn off or on).
Deep brain stimulation
How often does the generator for deep brain stimulation have to be replaced?
3-5 years
What is a new, controversial procedure that uses dopamine-producing fetal brain tissue or fetal pig tissue?
tissue implantation
T or F: Clients with PD may experience disrupted sleep patterns.
True
T or F: Clients with PD may experience social isolation, impaired relationships and sexual dysfunction because of rigidity, fatigue, depression or other psychosocial issues.
True
T or F: Clients with PD may experience fluctuating energy levels during the day.
True
T or F: OT intervention for clients with PD should include energy conservation and pacing, including prioritizing and planning important activities around medication times to ensure participation when medications are most effective.
True
What are some strategies you can provide to a client with PD to help manage freezing?
Avoiding crowds, tight spaces, and turns or corners, reducing distractions and avoiding multitasking, eliminating clutter in pathways and avoiding rushing to answer the phone or door.
T or F: Active music therapy can enhance motor skills (specifically bradykinesia), emotional health, ADL performance, and quality of life.
True
T or F: You should encourage clients with PD to eat smaller portions, remove distractions and eat more slowly.
True
T or F: Stress from rushing increases symptoms of clients with PD.
True
T or F: Distal wrist weights can be effective in decreasing tremors
True
T or F: Using distal muscles can help stabilize proximal joints and muscles, which may reduce tremors.
False; using PROXIMAL muscles can help stabilize DISTAL joints and muscles, which may reduce tremors.
